All questions
Question 1
In a long-term care facility, an RN supervises an LPN and a UAP. A 90-year-old resident has a stage 2 pressure injury on the coccyx with a prescribed dressing change. The RN should assign which task to the LPN?
- Perform the initial wound assessment and determine whether the wound is worsening
- Change the prescribed dressing and document the wound appearance, reporting any concerns to the RN (correct answer)
- Debride necrotic tissue at the bedside
- Develop the wound care plan and select appropriate products for treatment
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, delegating stable wound care to LPNs. The correct answer, changing the dressing and documenting while reporting concerns, properly applies delegation principles as LPNs are trained for routine wound procedures. The distractors represent common delegation errors: initial assessments and determinations are RN responsibilities; debridement requires advanced skills; and developing plans is RN-led. Effective delegation in wound care relies on clear reporting protocols. RNs should oversee and evaluate healing progress. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 2
In an acute care medical-surgical unit, an RN is caring for four clients with the help of one licensed practical nurse (LPN) and one unlicensed assistive personnel (UAP). One client is a 68-year-old with chronic obstructive pulmonary disease who is stable on 2 L/min nasal cannula and needs assistance with morning hygiene. Which task can the RN delegate to the UAP?
- Teach pursed-lip breathing to reduce dyspnea during activity
- Assist the client with a bed bath and oral care while monitoring for shortness of breath (correct answer)
- Assess lung sounds and determine whether oxygen flow should be increased
- Administer a prescribed inhaled bronchodilator via metered-dose inhaler
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, ensuring tasks match the UAP's scope of practice for stable clients with predictable needs. The correct answer, assisting with a bed bath and oral care while monitoring for shortness of breath, properly applies delegation principles because it involves routine hygiene assistance and observation of obvious signs, which UAPs are trained to perform and report. The distractors represent common delegation errors: teaching pursed-lip breathing requires educational skills beyond UAP scope; assessing lung sounds and adjusting oxygen involves clinical judgment reserved for RNs; and administering bronchodilators is a medication task typically for LPNs or RNs. Effective delegation involves evaluating the client's stability and the task's complexity before assigning. RNs must supervise and follow up on delegated tasks to ensure safety. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 3
On an acute care unit, an RN is delegating to an LPN and a UAP. A 52-year-old client is 6 hours postoperative after an uncomplicated appendectomy and is stable; the client has a new order to advance diet as tolerated. Which delegation decision by the RN requires reconsideration?
- Ask the UAP to assist the client to sit up and begin clear liquids, reporting nausea or vomiting
- Ask the LPN to administer prescribed oral analgesics for pain rated 4/10
- Ask the LPN to monitor the incision dressing for increased drainage and report changes
- Ask the UAP to assess bowel sounds and decide whether the diet can be advanced (correct answer)
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, prohibiting UAPs from performing assessments or making clinical decisions. The correct answer, asking the UAP to assess bowel sounds and decide on diet advancement, requires reconsideration because assessment and judgment are RN responsibilities. The distractors represent common delegation errors by being appropriate: UAPs can assist with positioning and report symptoms; LPNs can administer oral analgesics; and LPNs can monitor dressings. Effective delegation postoperatively ensures tasks align with recovery protocols. RNs must verify readiness for advancements like diet. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 4
In an acute care unit, an RN is supervising an LPN and a UAP. A 56-year-old client with type 2 diabetes is stable and has a new order for pre-meal capillary blood glucose checks and sliding-scale insulin. Which delegation decision by the RN requires reconsideration?
- Assign the UAP to obtain the pre-meal capillary blood glucose and report the result to the RN
- Assign the LPN to administer the sliding-scale subcutaneous insulin per protocol
- Assign the UAP to teach the client how to recognize signs of hypoglycemia (correct answer)
- Have the RN verify the insulin dose calculation before administration
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, avoiding delegation of teaching to UAPs. The correct answer, assigning the UAP to teach signs of hypoglycemia, requires reconsideration because teaching is outside UAP scope and requires clinical knowledge. The distractors represent common delegation errors by being appropriate: UAPs can obtain blood glucose if trained; LPNs can administer insulin per protocol; and RNs should verify high-risk medications like insulin. Effective delegation for diabetes management prioritizes education by qualified staff. RNs must oversee protocols and correct improper assignments. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 5
In a long-term care facility, an RN supervises an LPN and a UAP. An 86-year-old resident with chronic constipation is stable and has a scheduled stool softener and a new as-needed suppository order. The RN should assign which task to the LPN?
- Insert the prescribed suppository after assessing for contraindications and documenting the result (correct answer)
- Develop a bowel program and evaluate dietary fiber needs for the resident
- Assess abdominal distention and decide whether to notify the provider for possible obstruction
- Teach the resident and family about long-term constipation management and medication risks
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, delegating medication administration like suppositories to LPNs for chronic issues. The correct answer, inserting the suppository after assessing contraindications and documenting, properly applies delegation principles as LPNs can perform these tasks with basic checks. The distractors represent common delegation errors: developing programs is RN planning; assessing distention requires RN judgment; and teaching management is RN-led. Effective delegation for constipation focuses on routine interventions. RNs should evaluate overall bowel function. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 6
On a medical-surgical unit, an RN is caring for clients with an LPN and a UAP. A 66-year-old client has a peripheral intravenous catheter with maintenance fluids and reports pain and swelling at the site. Which client care task requires RN intervention?
- Assess the intravenous site for infiltration or phlebitis and take appropriate action per policy (correct answer)
- Ask the UAP to elevate the extremity and apply a warm compress without assessing the site
- Ask the LPN to document the client's report of discomfort in the chart
- Ask the UAP to obtain vital signs and report any fever
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person while requiring RN intervention for IV complications. The correct answer, assessing the IV site for infiltration or phlebitis, requires RN intervention because it involves clinical judgment and potential actions like discontinuation. The distractors represent common delegation errors: UAPs should not apply treatments without assessment; LPNs can document but not assess; and UAPs can obtain vital signs. Effective delegation for IV care prioritizes RN evaluation of issues. RNs must act to prevent further complications. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 7
In a long-term care facility, an RN is supervising an LPN and a UAP. A 77-year-old resident with dysphagia has an order for thickened liquids and aspiration precautions. Which task can the RN delegate to the UAP?
- Assess lung sounds after meals and determine whether aspiration pneumonia is developing
- Evaluate swallowing effectiveness and determine whether the diet consistency should be changed
- Teach the resident compensatory swallowing techniques and rationale for thickened liquids
- Assist the resident with meals using prescribed aspiration precautions and report coughing or wet voice (correct answer)
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, delegating mealtime assistance to UAPs with precautions. The correct answer, assisting with meals using precautions and reporting symptoms, properly applies delegation principles because it involves routine support and observation. The distractors represent common delegation errors: evaluating swallowing is RN or specialist role; teaching techniques requires qualified staff; and assessing lungs is RN assessment. Effective delegation for dysphagia ensures safety protocols are followed. RNs must oversee and reassess risks. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 8
During a high-volume shift in the emergency department, an RN is working with an LPN and a UAP. A 45-year-old client with a simple laceration to the forearm is stable after triage and needs a tetanus booster as ordered. The RN should assign which task to the LPN?
- Perform the initial focused assessment and determine triage priority
- Provide discharge teaching about wound care and signs of infection
- Administer the intramuscular tetanus booster after verifying the order and allergies (correct answer)
- Suture the laceration using sterile technique
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, matching tasks to the LPN's scope for stable clients and routine procedures. The correct answer, administering the intramuscular tetanus booster after verifying the order and allergies, properly applies delegation principles because LPNs are licensed to administer injections and perform verifications under RN supervision. The distractors represent common delegation errors: performing initial assessments and triage requires RN judgment; providing discharge teaching involves comprehensive education typically led by RNs; and suturing lacerations is an advanced skill reserved for providers or specially trained RNs. Effective delegation requires assessing the team's competencies and the task's requirements. RNs should communicate clear instructions and expectations for reporting. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 9
On an acute care telemetry unit, an RN is delegating tasks to an LPN and a UAP. A 72-year-old client is 1 day postoperative after a hip replacement and is stable; the client needs assistance ambulating to the chair with a gait belt. Which task can the RN delegate to the UAP?
- Evaluate the client's pain level and decide whether to request a medication change
- Assist the client to the chair using a gait belt and report any dizziness or increased pain (correct answer)
- Perform neurovascular assessment of the operative leg
- Administer prescribed intravenous opioid analgesia before ambulation
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, delegating routine mobility assistance to UAPs for stable postoperative clients. The correct answer, assisting to the chair using a gait belt and reporting dizziness or pain, properly applies delegation principles as it involves basic ambulation support and observation within UAP scope. The distractors represent common delegation errors: evaluating pain and requesting medication changes requires RN judgment; performing neurovascular assessments is an RN responsibility; and administering IV opioids is typically for RNs due to monitoring needs. Effective delegation considers the client's postoperative status and task predictability. RNs should provide clear instructions and require immediate reporting of changes. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 10
In the emergency department, an RN is working with an LPN and a UAP. A 67-year-old client with chest discomfort is moved to a monitored bed and appears pale and diaphoretic. Which delegation decision by the RN requires reconsideration?
- Assign the UAP to obtain a set of vital signs while the RN remains at the bedside
- Assign the LPN to place the client on continuous cardiac monitoring per protocol
- Assign the UAP to obtain a 12-lead electrocardiogram because it is a routine procedure (correct answer)
- Have the RN perform a focused assessment and prioritize rapid provider notification
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, avoiding delegation of specialized procedures like ECGs to UAPs. The correct answer, assigning the UAP to obtain a 12-lead ECG, requires reconsideration because ECGs require trained personnel like technicians or LPNs. The distractors represent common delegation errors by being appropriate: UAPs can obtain vital signs; LPNs can apply monitoring; and RNs perform assessments. Effective delegation in cardiac emergencies prioritizes rapid, skilled responses. RNs must coordinate urgent care. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 11
On an acute care unit, an RN is delegating tasks to an LPN and a UAP. A 40-year-old client with asthma is stable and requests help using a peak flow meter that was taught earlier in the day. The RN should assign which task to the LPN?
- Reinforce the previously taught peak flow meter technique and document the client's return demonstration (correct answer)
- Perform the initial respiratory assessment and establish baseline peak flow values
- Adjust the client's asthma action plan based on peak flow trends and symptoms
- Teach new information about long-term controller medications and step-up therapy
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, delegating reinforcement of asthma tools to LPNs. The correct answer, reinforcing peak flow technique and documenting demonstration, properly applies delegation principles as LPNs can reinforce prior teaching. The distractors represent common delegation errors: initial assessments are RN responsibilities; adjusting plans requires RN judgment; and teaching new information is RN-led. Effective delegation in asthma care builds on established education. RNs should monitor trends and adjust therapy. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 12
In a community health clinic, an RN is coordinating care for a family and working with a UAP and an LPN. A 6-year-old child is scheduled for a well-child visit and needs height, weight, and vital signs obtained before the RN assessment. Which task can the RN delegate to the UAP?
- Interpret growth percentiles and counsel the parent about nutrition changes
- Provide anticipatory guidance about immunizations and school readiness
- Assess developmental milestones and determine whether referrals are needed
- Obtain height, weight, and vital signs using age-appropriate equipment and document the results (correct answer)
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, delegating routine measurements to UAPs in clinic settings for stable children. The correct answer, obtaining height, weight, and vital signs and documenting, properly applies delegation principles because these are non-invasive, standard tasks UAPs can perform accurately. The distractors represent common delegation errors: providing anticipatory guidance involves teaching reserved for RNs; assessing milestones and referrals requires RN judgment; and interpreting growth and counseling on nutrition is an RN role. Effective delegation in pediatrics ensures tasks are age-appropriate and supervised. RNs must verify data and integrate it into assessments. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 13
On an acute care unit, an RN is delegating tasks to an LPN and a UAP. A 50-year-old client is stable after a blood transfusion and needs post-transfusion vital signs per protocol. Which delegation decision by the RN requires reconsideration?
- Assign the UAP to obtain and document post-transfusion vital signs and report abnormal findings immediately
- Assign the RN to evaluate for delayed transfusion reaction symptoms if the client reports chills or back pain
- Assign the LPN to discontinue the intravenous line if the client develops hives and shortness of breath (correct answer)
- Assign the LPN to monitor the intravenous site for patency and document the completion time of the transfusion
Explanation: This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, avoiding delegation of emergency management to LPNs without RN oversight. The correct answer, assigning the LPN to discontinue the IV for reaction symptoms, requires reconsideration because acute transfusion reactions need immediate RN intervention and judgment. The distractors represent common delegation errors by being appropriate: UAPs can obtain vital signs and report; RNs evaluate reactions; and LPNs can monitor sites. Effective delegation post-transfusion ensures protocol adherence. RNs must be available for complications. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 14
In a community health home-visit program, an RN is working with an LPN and a UAP. A 68-year-old client with osteoarthritis is stable and needs a home safety check to reduce fall risk (lighting, loose rugs, and clear pathways). Which task can the RN delegate to the UAP?
- Develop the individualized fall prevention plan, including specific lighting and rug modifications, and coordinate all necessary referrals to community resources.
- Assess the client's gait and determine whether an assistive device prescription is needed, then report your conclusions to the RN.
- Teach the client a new exercise program to improve strength and balance, and evaluate how well the client performs the exercises.
- Use a checklist to identify environmental fall hazards in the home and report findings to the RN. (correct answer)
Explanation: Delegation to a UAP is appropriate for routine, structured tasks that do not require nursing judgment. Using a checklist to identify environmental fall hazards is exactly such a task, and the UAP reports findings so the RN can act. Developing an individualized fall prevention plan and coordinating referrals requires the RN's assessment and planning skills, not a UAP. Assessing gait and deciding whether an assistive device prescription is needed involves clinical evaluation and prescriptive authority, also outside the UAP's scope. Teaching a new exercise program and evaluating the client's performance requires professional education and ongoing assessment, which cannot be delegated to a UAP. Always apply the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
Question 15
In a community health setting, an RN is coordinating care with an LPN and a UAP for an older adult. A 74-year-old client with newly diagnosed hypertension needs education on home blood pressure monitoring. The RN should assign which task to the LPN?
- Provide initial comprehensive teaching on hypertension pathophysiology and long-term complications, including lifestyle modifications and medication adherence
- Reinforce instructions on how to use the home blood pressure cuff and document return demonstration (correct answer)
- Assess for target-organ damage, including renal or visual changes, and determine need for urgent provider referral
- Develop the client's individualized care plan and set follow-up intervals, incorporating input from the healthcare team
Explanation: The correct delegation assigns the LPN to reinforce blood pressure cuff technique and document the client's return demonstration. LPNs can reinforce previously taught skills, but they cannot provide initial comprehensive teaching, which requires RN knowledge of pathophysiology and complications. Similarly, assessing for target-organ damage requires advanced assessment and judgment, an RN responsibility, and developing an individualized care plan is an RN leadership function. The RN must retain tasks that involve assessment, planning, and evaluation. By choosing the task that falls within LPN scope, you apply the right task and right person principles of delegation.
Question 16
In a long-term care facility, an RN oversees an LPN and a UAP. An 83-year-old resident with dementia is ambulatory but has a high fall risk and needs toileting every 2 hours. Which task can the RN delegate to the UAP?
- Implement the toileting schedule and assist the resident to the bathroom using prescribed safety measures. (correct answer)
- Assess changes in the resident's gait and update the fall prevention plan with the latest findings.
- Evaluate the effectiveness of a newly started sedative medication on the resident's fall risk during the scheduled toileting round.
- Teach the family strategies to reduce agitation and wandering during the resident's next visit home.
Explanation: Delegation to a UAP is appropriate for routine, low-risk tasks that follow an established plan without requiring independent nursing judgment. Implementing the toileting schedule and assisting the resident to the bathroom with prescribed safety measures is exactly that kind of task: the UAP follows the schedule and safety measures already set for the resident. The option about assessing the resident's gait changes and updating the fall prevention plan cannot be delegated because interpreting findings and revising the care plan require the RN's clinical judgment. The option about evaluating a newly started sedative medication cannot be delegated because UAPs cannot independently judge whether a medication is effective; that is an RN responsibility. The option about teaching the family strategies to reduce agitation and wandering also cannot be delegated because patient and family education requires the RN's assessment of learning needs and licensed nursing judgment. The correct delegation is the uroap activity that can be done safely under clear direction and supervision.
Question 17
In an acute care medical-surgical unit, the RN is caring for four clients with help from one licensed practical nurse (LPN) and one unlicensed assistive personnel (UAP). Which task can the RN delegate to the UAP for a 68-year-old client who is 1 day postoperative after a total hip replacement and is hemodynamically stable?
- Reinforce the RN's teaching about hip precautions and show the client how to position the abduction pillow
- Assist the client to the chair using a gait belt and report any dizziness or increased pain (correct answer)
- Assess the surgical dressing for drainage and document the wound appearance, including color and odor
- Administer the prescribed as-needed opioid analgesic for pain rated 7/10 and document the response in the MAR
Explanation: UAPs can be delegated routine tasks with predictable outcomes that do not require nursing judgment. Helping this stable postoperative client to the chair with a gait belt is such a task, and the UAP should report dizziness or increased pain because reporting observations is within UAP responsibility. Reinforcing the RN's teaching and demonstrating abduction-pillow positioning require client education skills beyond UAP scope. Assessing the surgical dressing and documenting wound appearance, including color and odor, is a nursing assessment, not a task for a UAP. Administering a prescribed opioid and documenting the response involve medication administration and evaluation, which only licensed personnel can do. Therefore, the ambulation assistance with gait belt plus reporting of client changes is the only task matching UAP scope.
Question 18
In a long-term care facility, an RN is supervising an LPN and a UAP during the morning medication pass. A 79-year-old resident with hypertension is stable and has a new prescription for an oral antihypertensive started yesterday. Which client care task requires RN intervention?
- The LPN reinforces prior teaching about changing positions slowly for the resident who has tolerated the medication since yesterday
- The LPN administers scheduled oral medications to residents whose conditions are unchanged from earlier this morning
- The UAP records the resident's intake of 240 mL and output of 300 mL on the designated flow sheet
- The UAP reports the resident feels dizzy when standing and has a blood pressure of 88/54 mm Hg (correct answer)
Explanation: The LPN reinforcing prior teaching about changing positions slowly is a follow-up task within the LPN's scope, so the RN does not need to intervene. The LPN administering scheduled oral medications to residents whose conditions are unchanged is also a routine medication pass within LPN scope. The UAP recording a resident's intake and output is a standard UAP assignment. None of these actions presents a new, unstable condition requiring the RN's judgment. The UAP reporting that the resident feels dizzy when standing and has a blood pressure of 88/54 mm Hg is the task that calls for RN action. This resident has just started an oral antihypertensive; dizziness on standing and that low a blood pressure suggest orthostatic hypotension or a possible adverse drug effect. The RN must assess the resident, evaluate the medication, and decide whether to hold it or notify the provider.
Question 19
In a community health setting, the RN is coordinating a home visit and working with a UAP who can obtain routine measurements and report observations. Which task can the RN delegate to the UAP for a 70-year-old client with controlled hypertension who is being seen for a scheduled blood pressure follow-up?
- Review the client's medication adherence barriers, adjust the hypertension care plan, and document the changes.
- Teach the client how to follow a low-sodium diet, read nutrition labels, and prepare simple meals.
- Measure blood pressure in both arms, record the readings, and report abnormal values to the RN. (correct answer)
- Evaluate for early signs of end-organ damage, determine need for urgent referral, and notify the RN.
Explanation: For a stable client with controlled hypertension, the delegable task is routine measurement: the UAP can take blood pressure in both arms, record the readings, and report abnormal results to the RN. This is within the UAP's role of obtaining and communicating routine data without interpreting them. Reviewing medication adherence barriers and adjusting the care plan requires the RN to assess the client and modify the plan of care; this is not delegable. Teaching the client to follow a low-sodium diet and read nutrition labels is patient education requiring nursing judgment about readiness and comprehension; the UAP cannot perform teaching as a delegated task. Evaluating for early signs of end-organ damage and determining whether urgent referral is needed requires clinical assessment and decision-making beyond the UAP's scope. In delegation, routine monitoring and reporting can be delegated, but assessment, teaching, and evaluation remain with the RN.
Question 20
In a long-term care facility, the RN is supervising an LPN and a UAP while caring for multiple residents. Which delegation decision by the RN requires reconsideration for an 82-year-old resident with diabetes who reports new numbness and a small blister on the right foot?
- Assign the UAP to obtain the resident's vital signs and report any fever
- Assign the LPN to administer the resident's scheduled oral medications
- Assign the UAP to perform a full foot assessment and apply a dressing to the blister (correct answer)
- Plan to assess the resident's foot and circulation after completing a medication reconciliation
Explanation: This question tests delegation and assignment principles by identifying inappropriate delegation decisions. The key principle is recognizing tasks that exceed the UAP's scope of practice. Assigning the UAP to perform a full foot assessment and apply a dressing (option C) requires reconsideration because assessment is a nursing function that cannot be delegated to UAPs, and wound care requires nursing judgment. Options A (obtaining vital signs) and B (LPN administering oral medications) are appropriate delegations within their respective scopes, while option D represents appropriate RN prioritization but not a delegation error. The decision-making principle is that assessment, evaluation, and tasks requiring nursing judgment cannot be delegated to UAPs, especially for high-risk clients like those with diabetes and potential complications. When supervising delegation, always verify that the task matches the team member's education, training, and legal scope of practice, particularly avoiding delegation of assessment to unlicensed personnel.